Update: What Virginia’s Health Plans are Doing in the Medicaid and Commercial Spaces in the face of COVID-19?

Allyn HodginsUncategorized

Health insurers in Virginia are responding to the COVID-19 coronavirus in a myriad of ways. Plans are eliminating barriers to care including waiving cost-shares, providing more virtual care options, and keeping members updated through mobile apps and websites with the latest information.

What follows is a high level summary of the health insurance industry’s response in Virginia, and we would encourage you to reach out to individual plans with specific requests. We have also included the nurse or physician line for each plan below, which is a good first step for members to contact if they suspect they may have contracted the virus.

In the commercial market (individual, small group, and large group).

  • Health insurers are encouraging the use of telemedicine and virtual sites of care. This includes the following. A detailed chart across plans is attached.
    • Encouraging the use of 24/7 nurse phone lines to virtually access clinical resources at no cost to members. The nurses are trained in the latest screening and testing referral protocols. The numbers for each plan are listed below.
    • Paying for telephone-only consultations with clinician staff of primary care, general practice, internal medicine, pediatrics, OBGYN, and nurse practitioners with no member out-of-pocket cost.
    • Utilizing mobile apps to answer member questions and conduct coronavirus assessments based on guidelines from the CDC and NIH.
    • Providing emotional support for those members experiencing stress or anxiety via a 24/7 phone line and online at no cost to members.
  • Health insurers across Virginia and the United States have agreed to waive cost-sharing requirements for testing.
  • Health insurers have eliminated prior authorization requirements for medically necessary diagnostic tests and covered services related to COVID-19 diagnosis.
  • Health insurers have waived early medication refill limits on 30-day maintenance medications.
  • Health insurers are creating care packages to send to members diagnosed with COVID19 and proactively reaching out to those members who may be more at risk at contracting the virus.
  • Health insurers are working with pharmacy partners to provide free delivery of medications and assist with mailing prescriptions.
  • Health insurers are working with lab partners to support access to testing as it becomes available.
  • The IRS has relaxed rules in regards to high deductible health plans, allowing insurers to lower cost-sharing and deductible amounts related to COVID testing and treatment.
  • In the self-insured market, which comprises nearly 40% of the insured in Virginia and where the self-insured company makes coverage determinations, some insurance company administrators are automatically opting in companies to the waived cost-sharing provisions.
  • Some health plans are allowing employers to retain health insurance coverage for employees who have been furloughed provided that the businesses maintain one full time employee, premiums are paid, and the benefits are offered on a uniform nondiscriminatory basis. This is also subject to applicable state and federal law.

In Medicaid, which is administered by the six managed care organizations (MCOs).

  • MCOs are in regular contact with the Department of Medical Assistance Services (DMAS) to look for ways to deliver critical services without a face-to-face interaction. This includes looking at telehealth and telemedicine options for providers and patients.

In Medicare.

Applicable to all lines of business and following federal guidance (httpss://www.cisa.gov/sites/default/files/publications/CISA-Guidance-on-Essential-Critical-Infrastructure-Workers-1-20-508c.pdf), insurers are working with state government to have insurance company employees deemed essential so if further restrictions are put in place, insurers can still maintain vital functions for members.

For more detailed information on what each health plan in Virginia is doing both in the commercial space, Medicaid and Medicare, see the individual company press releases below.

Aetna: httpss://www.cvshealth.com/covid-19

Anthem: httpss://ir.antheminc.com/news-releases/news-release-details/anthem-issues-updates-regarding-covid-19-testing-and-care?field_nir_news_date_value%5Bmin%5D=

CareFirst: httpss://www.member.carefirst.com/members/pop-up/coronavirus-information-and-illness-prevention.page

Cigna: httpss://www.cigna.com/newsroom/news-releases/2020/cigna-takes-additional-actions-to-protect-customers-and-communities-against-covid-19

Magellan: httpss://ir.magellanhealth.com/news-releases/news-release-details/magellan-health-offers-support-individuals-and-customers

Optima: httpss://www.optimahealth.com/documents/communications/news-releases/press%20release%20optima%20health%20addresses%20covid-19%20march%206%202020.pdf

Piedmont: httpss://www.pchp.net/index.php/docman-commercial-files/kens-cat/3055-covid19-press-release-031020/file.html

UnitedHealthcare: httpss://www.unitedhealthgroup.com/newsroom/2020/2020-03-18-covid19-uhc-support.html

Virginia Premier: httpss://www.virginiapremier.com/information-for-healthcare-professionals-coronavirus/

Each plan has a nurse line, the majority of which are available 24/7 to answer member questions.

Aetna: 800-556-1555

Anthem: 800-700-9184

CareFirst: 800-535-9700

Cigna: 888-726-3171 or 855-667-9722.

Magellan: Members should call the Member Service phone number on the back of their ID cards.

Optima: 800-394-2237

Piedmont: 844-447-8470

United: Members should call the Member Service phone number on the back of their ID cards.

Virginia Premier: 800-256-1982

This is an unprecedented time for our nation, and as such, the health insurance industry is taking unprecedented action to ensure members receive the care they need.